skip to main content
Show Results with:

Procedural sedation and analgesia for respiratory-gated MR-HIFU in the liver: a feasibility study

van Breugel, Johanna et al.

Journal of therapeutic ultrasound. Volume 4:Issue 1 (2016); pp 1-12 -- BioMed Central

Online access

  • Title:
    Procedural sedation and analgesia for respiratory-gated MR-HIFU in the liver: a feasibility study
  • Author: van Breugel, Johanna;
    Wijlemans, Joost;
    Vaessen, Hermanus;
    de Greef, Martijn;
    Moonen, Chrit;
    van den Bosch, Maurice;
    Ries, Mario
  • Found In: Journal of therapeutic ultrasound. Volume 4:Issue 1 (2016); pp 1-12
  • Journal Title: Journal of therapeutic ultrasound
  • Subjects: Ultrasonic waves--Therapeutic use--Periodicals; Ultrasonics in medicine--Periodicals; Periodicals; Procedural sedation and analgesia--General anesthesia--MR-HIFU--Liver--Thermal ablation; Dewey: 615.832305
  • Rights: legaldeposit
  • Publication Details: BioMed Central
  • Abstract: AbstractBackgroundPrevious studies demonstrated both pre-clinically and clinically the feasibility of magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablations in the liver. To overcome the associated problem of respiratory motion of the ablation area, general anesthesia (GA) and mechanical ventilation was used in conjunction with either respiratory-gated energy delivery or energy delivery during induced apnea. However, clinical procedures requiring GA are generally associated with increased mortality, morbidity, and complication rate compared to procedural sedation and analgesia (PSA). Furthermore, PSA is associated with faster recovery and an increased eligibility for non- and mini-invasive interventions.MethodsIn this study, we investigate both in an animal model and on a small patient group the kinetics of the diaphragm during free-breathing, when a tailored remifentanil/propofol-based PSA protocol inducing partial respiratory depression is used. Subsequently, we demonstrate in an animal study the compatibility of the resulting respiratory pattern of the PSA protocol with a gated HIFU ablation in the liver by direct comparison with gated ablations conducted under GA. Wilcoxon signed-rank tests were performed for statistical analysis of non-perfused and necrosed tissue volumes. Duty cycles (ratio or percentage of the breathing cycle with the diaphragm in its resting position, such that acoustic energy delivery with MR-HIFU was allowed) were statistically compared for both GA and PSA using student'sttests.ResultsIn both animal and human experiments, the breathing frequency was decreased below 9/min, while maintaining stable vital functions. Furthermore an end-exhalation resting phase was induced by this PSA protocol during which the diaphragm is virtually immobile. Median non-perfused volumes, non-viable volumes based on NADH staining, and duty cycles were larger under PSA than under GA or equal.ConclusionsWe conclude that MR-HIFU ablations of the liver under PSA are feasible and potentially increase the non-invasive nature of this type of intervention.
  • Identifier: System Number: LDEAvdc_100081284717.0x000001; Journal ISSN: 2050-5736; 10.1186/s40349-016-0063-x
  • Publication Date: 2016
  • Physical Description: Electronic
  • Shelfmark(s): ELD Digital store

Searching Remote Databases, Please Wait